Gerwig M, Dimitrova A, Kolb F P, Maschke M, Brol B, Kunnel A, Böring D, Thilmann A F, Forsting M, Diener H C, Timmann D
Department of Neurology, University of Essen, Department of Neurology, Fachklinik Rhein-Ruhr, Essen, Germany.
Brain. 2003 Jan;126(Pt 1):71-94. doi: 10.1093/brain/awg011.
The aim of the present study was to compare eyeblink conditioning in cerebellar patients with lesions including the territory of the superior cerebellar artery (SCA) and in patients with lesions restricted to the territory of the posterior inferior cerebellar artery (PICA). The cerebellar areas known to be most critical in eyeblink conditioning based on animal data (i.e. Larsell lobule H VI and interposed nucleus) are commonly supplied by the SCA. Eyeblink conditioning was expected to be impaired in SCA, but not in PICA patients. A total of 27 cerebellar patients and 25 age-matched controls were tested. Cerebellar lesions were primarily unilateral (n = 20). Most patients suffered from ischaemic infarctions of the SCA (n = 11) or the PICA (n = 13). The other patients presented with cerebellar tumours (n = 2) and cerebellar agenesis (n = 1). The extent of the cortical lesion (i.e. which lobuli were affected) and possible involvement of the cerebellar nuclei was determined by 3D-MRI. As expected, the ability to acquire classically conditioned eyeblink responses was significantly reduced in the group of all cerebellar patients compared with the controls. In the patients with unilateral cerebellar lesions, conditioning deficits were present ipsilaterally. In SCA patients with lesions including hemispheral lobules VI and Crus I, eyeblink conditioning was significantly reduced on the affected side compared with the unaffected side. No significant difference between the affected and unaffected sides was present in patients with lesions restricted to the common PICA territory (i.e. Crus II and below). Conditioning deficits were neither significantly different in SCA patients with pure cortical lesions compared with SCA patients with additional nuclear impairment nor in SCA patients with unilateral lesions compared with SCA patients with bilateral lesions. To summarize, unilateral cortical lesions of the superior cerebellum appear to be sufficient to reduce eyeblink conditioning in humans significantly.
本研究的目的是比较小脑上动脉（SCA）供血区有病变的小脑患者与病变局限于小脑后下动脉（PICA）供血区的患者的眨眼条件反射。基于动物数据，已知在眨眼条件反射中最关键的小脑区域（即拉塞尔小叶H VI和间位核）通常由SCA供血。预计SCA患者的眨眼条件反射会受损，但PICA患者不会。共对27例小脑患者和25例年龄匹配的对照者进行了测试。小脑病变主要为单侧（n = 20）。大多数患者患有SCA（n = 11）或PICA（n = 13）的缺血性梗死。其他患者表现为小脑肿瘤（n = 2）和小脑发育不全（n = 1）。通过三维磁共振成像（3D-MRI）确定皮质病变的范围（即哪些小叶受到影响）以及小脑核是否可能受累。正如预期的那样，与对照组相比，所有小脑患者组中获得经典条件性眨眼反应的能力显著降低。在单侧小脑病变的患者中，条件反射缺陷出现在同侧。在病变包括半球小叶VI和小脑脚I的SCA患者中，与未受影响侧相比，受影响侧的眨眼条件反射显著降低。在病变局限于PICA常见供血区（即小脑脚II及以下）的患者中，受影响侧与未受影响侧之间无显著差异。与伴有额外核损伤的SCA患者相比，纯皮质病变的SCA患者的条件反射缺陷无显著差异；与双侧病变的SCA患者相比，单侧病变的SCA患者的条件反射缺陷也无显著差异。总之，小脑上部的单侧皮质病变似乎足以显著降低人类的眨眼条件反射。
